Sam Quinones’ ‘Dreamland’ is a haunting tale of opiate abuse in the heartland

In many American towns, scoring Mexican black-tar heroin is as easy as ordering a pizza — quite literally, the addict calls, and a driver delivers the goods.

The similarities with a fast-food franchise don’t stop there. Dealers earn a set wage. Clients respond to satisfaction surveys rating customer service and quality. Job titles include “regional sales manager” or “cell supervisor.”

This explosive rise of heroin is detailed by Sam Quinones in “Dreamland: The True Tale of America’s Opiate Epidemic.”

Using expert storytelling and exhaustive detail, Quinones chronicles the perfect storm of circumstances that cleared the way for the Mexican narcotic to infiltrate our small and midsize communities over the last two decades.

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His story centers on Portsmouth, Ohio, home to the nation’s first pill mill. Following the release of OxyContin in 1996, corrupt physicians seized the opportunity to get rich quick. Addicts traveled to pain clinics by the carload, bearing forged MRIs and false complaints of pain, sometimes trading sexual favors for pills. Soon, Portsmouth had more pills per capita than any other city.

“If you see lines of people standing around outside smoking, people getting pizza delivered, fist fights, and traffic jams, if you see people in pajamas, who don’t care what they look like in public — that’s a pill mill,” said one seasoned detective. “And that’s what popped up all over Portsmouth.”

As OxyContin grew more prevalent, multidisciplinary pain management clinics all but disappeared. People believed they had the right to be pain-free, and pills were faster and cheaper than diet, exercise or therapy.

Opiate painkillers also were highly addictive, we have learned, although the so-called experts continually (and falsely) claimed less than 1 percent of patients became dependent on the drug.

Relentless marketing to physicians coupled with over-prescription to patients created a new class of addict.

Average people who believed they were safely managing their pain found themselves unable to quit. Young, white, suburban kids began dying of overdoses. Out of shame, most parents didn’t want to talk about it, but one grieving mother who did break her silence compared Purdue Pharma, the makers of OxyContin, to a “large, corporate drug cartel.”

It was into this grim scene that stepped the heroin-selling Xalisco Boys, an actual drug cartel.

Hailing primarily from Xalisco, a small, agricultural town in Nayarit on Mexico’s west coast, they quickly set up shop across the United States. But these entrepreneurs did things differently.

“The cells compete with each other, but competing drivers know each other from back home, so they’re never violent,” a former informant said. “They never carry guns. They work hard at blending in. They don’t party where they live. They drive sedans that are several years old. None of the workers use the drug.”

By avoiding big cities, they went unseen by sophisticated police departments. Young drivers carried tiny balloons filled with the potent drug in their cheeks so it could be swallowed if they were stopped.

Law enforcement officials gradually grew wise, but shutting down such a vast distribution network has proved daunting.

When OxyContin addicts discovered heroin was cheaper and easier to acquire than pills, making the switch was a no-brainer. The nation’s heroin abuse jumped from 373,000 people in 2007 to 620,000 in four years; 80 percent reported using a prescription painkiller first.

Despite their singular role in the epidemic, the dealers are not villainized by Quinones. Having lived in Mexico and written extensively about immigration, he understands the impulses driving these young men: money and status.

Their options are limited to dead-end, backbreaking labor, while a stint as a driver can net a few thousand dollars to send home, as well as several pairs of much-coveted Levi’s 501 jeans.

“They were just kids, trying to make money — the American Dream kind of deal,” one former junkie told Quinones. “They talked about how little money they’d make back home and how great it was they could come and get away with this and help their families.”

They did not help the families of Portsmouth, of course.

Quinones poignantly illustrates the downfall of Dreamland, the eponymous public pool that closed as a direct result of the heroin scourge.

What was once a prominent multigenerational gathering place became a rundown relic of a once-thriving community.

Dreamland may be gone for good, but the story ends on a high note: Many addicts are now moving back to Portsmouth to get clean.

As Quinones says, the town may be “as scarred and beaten as an addict’s arm,” but the dreamers are hopeful they can heal and start anew.

Angela Lutz is an intern in the University of Missouri-Kansas City’s MFA creative writing program.